It takes a nut

My most recent venture in community theater hits on a topic that has always been dear to my heart:  the overuse and vulnerability to abuse of psychiatric labeling and “psychotropic medication,” from tranquilizers to anti-depressants, from anti-psychotics to social anxiety alleviators.   

I was “trained as a psychologist,” meaning I got a doctorate in Clinical Psychology (NYU).   Back  then, ages ago,  when I was a graduate student, I lamented that so much of “therapy” devolved to the prescription of a psychoactive drug and a series of a few brief contacts with a “mental health professional” (psychiatrist, psychologist, or social worker).   The situation is far more extreme today than it was then.

In my college and graduate years, the criticism of the “medical model” was on the ascendancy.   The logic seemed compelling:   critical elements of the terminology and structure of medical philosophy and practice simply did not apply or, worse, misled us when applied to human problems.   Was it every really possible to speak of “cure” in the medical sense that a seriously troubling personal problem could be effectively “treated” to the point that it became simply in the past, like a successfully removed appendix?  Did concepts like “prognosis” make much sense psychological problems?  Wasn’t medicine at best a rather inaccurate metaphor, a very weak fit, when transferred to talking about people’s problems in living?

Today, the medical model is more engrained than ever.   We have all been well-trained to believe that psychiatric diagnoses accurately define our psychological problems;  when we think of solutions, we immediately think of “medication,” — meaning a pharmacological concoction dreamed up by a megalithic drug company.   We even have images in our mind of how these drugs work in our brain, increasing or decreasing “serotonin uptake” or increase or decrease electrical activity is some part of our brains.   If the problem is personal, psychological, then the solution is chemical.

This is not to say that some drugs (no, I do not call them medicines;  they are no more “medicines” in the strict sense of having a specific effect on a specific disorder than the old patent medicines that used to be 75% alcohol!) don’t benefit some of the people some of the time, as Honest Abe might have said.   There’s no doubt that many people find themselves at least partially satisfied with how these pharmaceutical creations affect them.

But my experience is that, for all their fancy names and labels, theytend, in varying degrees, to either shut you down or speed you up.   Every one has side effects, some of which are pernicious, such as the agony many report in coming off a particular “medication.”  None have the kind of specificity that’s ascribed to them by their manufacturers.  None, that is to say, simply relieves specific symptoms and otherwise leave you well enough alone.  Tranquilizers slow you down and the “major tranquilizers” or “anti-psychotics” slow you down a whole lot more.  The uppers, whether to “help kids concentrate” or alleviate depression, zip you up.   The claims that this particular chemical composition has that particular psychological effect because of this particular thing that it does to the brain are largely pharmaceutical company hype.

So a psychiatrist will make a best guess about what’s most wrong with the patient and what pill is most likely to have a positive effect without creating some dramatically awful side-effect, counter-effect, or effect when the patient has to stop taking the pill for whatever reason.  And if the results are not good, then the doctor will prescribe something different and see if that seems to “work.”  Meanwhile, the patient isn’t talking to anyone about how to change their miserable relationships — or lack of them — let alone how their past miseries might be overcome at least to the extent that they stop screwing up their current life.

A lot of this comes out in the play we’re about to do (Nuts by Tom Topor). A person is accused of a crime.  She is convinced that she can demonstrate her innocence to a jury, but she is being held in a psychiatric hospital as crazy instead of being allowed to stand trial for the crime of which she is accused.   She is loaded with powerful anti-psychotics against her will.   She refuses to be forced to hide behind and be trapped behind being labeled “incapacitated,” nuts.

The play unveils the potential for abuse:  when small minded people are entrusted with power far disproportionate to their capacity for compassion and understanding of human nature, they can use the tools of psychiatric diagnosis and forceable treatment to impose their personal will on others for their own personal reasons, like their egos and or worse.

The point is not that every doctor who ever prescribes psychoactive drugs over the objection of the patient is an abusive, power-loving psychopath (Though who can forget Nurse Ratched from One Flew Over the Cuckoo’s Nest or the behavioral psychologist from A Clockwork Orange?).   Certainly their are some doctors who are legitimately and consistently compassionate;  there are some patients who definitively need something before they do some serious harm; but self-aggrandizing, self-righteous, mean-spirited, empathy-deficient mental health professionals do exist, and the danger of abuse is all too real.

Not all abuse is as dramatic as that depicted in film and theater, but the chronic overuse of attaching scientific-labels and calling them “diagnoses” is itself a form of abuse. Psychological problems, our difficulties-in-living our lives that limit our human potential, are too complex to be reduced to a set of “symptoms,”  a shopping list of behavioral symptoms that are very roughly connected to each other to form a modern diagnosis.    It becomes all to easy to call someone “a schizophrenic” as though this diagnosis defines who the person is.   It becomes all to easy to say that a person “is ADHD” or “has Attention Deficit Disorder” as though this were who the person is, as though this defines the person.

Labels are a double-edged sword.   On one level they are simply descriptive words, words that help us communicate about what’s wrong.   It is not that these words mean nothing:  the are often very evocative.   When we say that a person is clinically depressed, we are likely saying something real about the person.   But if we stop there, it is as though putting a label on a problem defines the problem.    

I have many times heard people, especially parents of troubled children, express how relieved they were to learn that their child was some specific diagnostic category, because it “now all made sense to me.”  Now the troubled person or the parent of the troubled person, has a word, a category, a definition, a name to call the problem. It is no longer a problem,  it is a  “condition.”

And with this “identification of the disorder,”  there ensues a terrible loss of responsibility. Terrible because people are nothing without responsibility for themselves.   It is responsibility that makes us human rather than automatons.   Whatever we do, whatever we feel, that is who we are.   If we deny our own responsibility for being who we are, then who are we?


For the record, I’m playing the abusive psychiatrist.   (Nuts by Tom ToporVermont Theater Company; Hooker-Dunham Theater, Brattleboro, VT;  January 24, 25, 26, 30, 31, and February 1 and 2; Fridays/Saturdays 7:30;  Sundays 3PM)















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